Report Cards

1
Report Cards Reputational Incentives

• Moreover, Hospitals have RIs to obtain a ()
  report cards
• Ranked among the top 10 hospitals in New York
  State for cardiac surgery and cardiac
  catheterization programs
• (CMS discourages hospital from using its data for
  advertisement and avoids ranking hospitals)

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2
Report Cards Reputational Incentives

• Disruptive Innovation Physicians
• Market impact of a (-) report card is more clear
  cut

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3
Report Cards Reputational Incentives

• NYS cardiac surgery registry
• 5 of surgeons with the lowest operative
  mortality exited the market
• 20 of surgeons with the highest operative
  mortality exited the market
• 2/3 of surgeons admitted to cherry picking
  patients

Ashish K. Jha and Arnold M. Epstein. The
predictive accuracy of the New York State
coronary artery bypass surgery report-card
system. 25 Health Aff 844, 84455 (2006)
4
Report Cards Reputational Incentives

• Objective evidence of cherry picking
  Statistically significant reduction in the number
  of redo-CABGs being performed

TR McLean, In New York State, do more
percutaneous coronary interventions mean fewer or
more complex referrals to cardiac surgeons? 6(1)
Am Heart Hospital J 30, 30-36 (2008).
5
Report Cards Reputational Incentives

• Just like hospitals, Physicians make use of ()
  report cards
• Dr. Ty Goletz is a top-rated orthopedic surgeon
  who has received numerous awards and accolades
  throughout the United States, including being
  chosen as one of San Antonios Top Doctors, and a
  Texas Super Doctor by Texas Monthly Magazine.

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6
Report Cards Reputational Incentives

• All I ever needed to know about report cards, I
  learned in 3rd grade They change behavior
• The Key question is how is the government going
  to use (capitalize) on this information?

McLean TR Will reputational incentives stimulate
a reversal of the physician brain drain?. J
Health Serv Res Policy 2008 1350-52 Werner RM
and Asch DA The Unintended Consequences of
Publicly Reporting Quality Information.
JAMA 2005 2931239-1244
7
Report Cards Reputational Incentives

• Answer
• Two new CMS initiatives
• Hospital Quality Initiative (HQI)
• Physician Quality Reporting Initiative (PQRI)

 
Image URL on request
8
Report Cards Reputational Incentives

• Common to both HQI PQRI are paradigm shifts
• Accountability shifts from structure (e.g. JC
  accreditation) to outcomes (e.g. SSI)
• Benchmarking for provider comparison

Brett Elliott Pay for Performance and the
Hospital Quality Initiative. Del Med Jrl 2005,
77(8)288-96.
9
Report Cards Reputational Incentives

• HQI
• MMA 501b Pub L 108-173 (117 Stat. 2066)
• But, CMS lacks statutory authority to collect
  provider specific data.
• Voluntary performance measurement reporting
  began 2004

Brett Elliott Pay for Performance and the
Hospital Quality Initiative. Del Med Jrl 2005,
77(8)288-96.